Dealing with Disputes and Appeals in North Carolina Workers’ Compensation Cases

For many injured workers, their workers’ compensation claims are straightforward and are approved with little delay. For many others, unfortunately, their claims are far more complex and quickly get bogged down in disputes, denials, and appeals. If you feel like your workers’ comp claim is an uphill battle, get the help you need by putting a workers’ compensation lawyer on your side who knows how to get the benefits you are entitled to. 

Don’t Get Discouraged

If your claim has been denied or you are encountering other disputes over your claim, you are not alone. Hundreds of workers’ compensation claims are denied across North Carolina every year. Many of these denials are due to issues that are easily solved if you know what to do. Many disputes can also be easily resolved, thus avoiding a denial down the road. The bottom line is that you shouldn’t lose hope or give up if your claim is not quickly approved. A workers’ compensation lawyer can help you get your case back on track. 

Be Proactive

The best thing to do if you are dealing with a dispute you can’t get resolved or your claim has been denied is to take action. One reason is that procrastinating can jeopardize your case.  There is a strict deadline for filing an appeal if your claim has been denied. Another reason why you should be proactive is that the sooner your case is resolved, the sooner you can get your benefits and start putting your injury behind you. Here are some ways that you can be proactive with your case that can make a big impact: 

• Gather and organize all documents and correspondence regarding your claim – these will be vital in the event that you have to file an appeal.
• Think carefully about what is in dispute or the reason for your denial – providing clarification, explanation, or additional documentation may be all that is needed to get your claim resolved. 
• Consult with a workers’ compensation lawyer – getting a lawyer involved will likely get the matter resolved more quickly than you could on your own. In addition, you should be aware that you can likely get legal representation without paying any legal fees out of pocket. 

Understand Your Options

In order to get the issue resolved, you need to know what options you have for moving forward. Most disputes in workers’ compensation claims revolve around the treating doctor’s assessment of your injury and limitations. For example: 

• Your treating doctor believes you are capable of returning to work, but you are still experiencing significant limitations. 
• Your treating doctor believes that you are able to work with restrictions that you believe are impractical or simply impossible. 
• Your doctor believes that you have reached Maximum Medical Improvement (MMI) but you believe additional improvement is possible with additional treatment. 

In these situations, you may need to request an independent medical examination or “IME.” While an IME can help your claim, it can also do damage. The timing of your request can also make a difference. We recommend that you consult with a workers’ compensation lawyer before requesting an IME if you are disputing your doctor’s recommendations. 

A denial of your claim is comparatively straightforward. When the North Carolina Industrial Commission (NCIC) denies a claim, workers have the right to proceed through a multi-step appeal process. The first step is to request a hearing with a deputy commissioner of the NCIC. Please note, however, that you must file your request within 14 days of your denial, or you risk losing all of your rights. 

Don’t Take It Personally

Delays and denials can be frustrating when you are unable to work and depend on your workers’ compensation benefits to make ends meet. Sometimes, it can even feel personal. Your employer may deny that your injury was work-related or otherwise dispute your claim. Your doctor may seem like they are more focused on saving money for the insurance company than making sure you get the treatment you need. 

Whatever the case may be, it is critical to stay focused. Lashing out at your employer or your treating doctor during an IME can have devastating consequences for your claim. If you need to file an appeal, you need to focus on the facts of your case and abstain from venting your personal frustrations. 

It’s not so much that the insurance company or the NCIC will retaliate against you as a result of raising these issues. Instead, the risk is that your frustration and anger will cloud the legal and factual issues that should be decided in your favor. 

This is one of the benefits of working with a workers’ compensation lawyer.  They can speak on your behalf. They will know how to build a compelling case that advocates for a fair outcome so you don’t have to worry about jeopardizing your claim. 

Get Legal Representation

Whether you are dealing with disputes or your claim has been denied, the best way to protect yourself is to hire an experienced workers’ compensation lawyer. They can assess the issues and find possible solutions. They know how to navigate the claim process, from resolving disputes to filing successful appeals, so that you can get your benefits as soon as possible. Perhaps most importantly, they can bring you peace of mind by handling your case so that you can focus on your recovery. 

Need Help with Your Workers’ Compensation Claim? Contact Martin & Jones Today

If you are unable to work due to a work-related injury or illness, you are facing a potential crisis. Fortunately, you don’t have to leave your future in the hands of other people who may not have your best interests in mind. Take control of your future by contacting Martin & Jones. We have more than four decades of experience helping injured workers get the workers’ compensation benefits they deserve. Call us today at 800-662-1234 to schedule a free consultation to discuss what we can do for you.